SOLO-International Op-Ed: Medicare, The Model of Government Health Insurance

atlascott's picture
Submitted by atlascott on Fri, 2009-10-09 22:27

SOLO-International Op-Ed: Medicare, The Model of Government Health Insurance

Scott DeSalvo
October 10, 2009

According to 2008 Federal government projections, a looming Medicare shortage is seven times the size of the one that Social Security faces and more than four times the entire federal debt.

Medicare, the health care program for the elderly, must find an estimated $36.3 trillion. This is not being addressed. In fact, since 2005, Medicare has been paying out more than it has collected, and the imbalance is getting worse.

But allow me to place a more human face on this for you, since we are all good and numb from big numbers with lots of zeros, and how they are a literal noose around the neck of America.

Suppose you are assisting in the care of a beloved elderly person, who is dying from lung failure, after having fought bladder cancer 5 years earlier, at the cost of her bladder.

Two separate medical conditions: (1) lung failure, for which nurses come to the home and give tranquilizers and breathing treatment of ever-lessening effectiveness, until death; and (2) no bladder inside her body, which means she pees into a bag glued to her stomach through an opening in her abdomen into which a tube is inserted, which, of course, leads to the bag.

Stupid Medicare Regulation #1: the hospice nurses, who come in 2 or 3x per week, ARE NOT ALLOWED to treat or care for her ostomy (opening in her body). They cannot order the bags, the gasket/wafer, the adhesive. They cannot help with that, period. JUST the condition for which she is dying.

Stupid Medicare Regulation #2: In order to get her needed supplies, Medicare contracts with a private medical supply company whose only client, you guessed it, is Medicare. So the idea is: in order to get your supplies mailed to you, you not only have to coordinate with Medicare (which I can assure you is as efficient, modern, and satisfying as a trip to the post office), but also with a monolithic private corporation with no accountability, and which must get a tad of info from you, then a bit of info from Medicare, then a smidge of info from you, then an approval number from Medicare. You can imagine the sort of dance that turns out to be.

When your beloved old woman whose kindness throughout your young life is one of the few bright candles you can recall does not get her medical supplies, then she lies in her own urine.

In the 9 months I have been involved in this, it has been screwed up twice, with no patient, doctor, or nurse intervention.

Screw up of supplies delivery #1: No supplies. Dear sweet woman, in early dementia, does not even remember that she is supposed to be wearing a bag. Lying in her urine, not complaining, sweet-souled dear that she is.

It seems, you see, that the automated computer system needed confirmation that the supplies were still needed and no one provided confirmation.

Understand, no one called anyone in the family to request information. We set the program up to auto-ship supplies on a 3 month basis. The computer told them to stop and they stopped. End of story.

Do you know how much information they need to start up the supplies for an elderly woman with the heart of angel, whose bladder has been permanently and totally and irretrievably removed for 5 years? A doctor's note, the date of surgery, the surgeon's name, the doctor's names and addresses, her Social Security Number, Date of Birth, Serial numbers from the old boxes of supplies, Prescitipn numbers, the date of the last shipment, the amounts of supplies from the last shipments, the name of the hospice nurse, hospice company, the COPD doctor and his name, address, telephone, and of course, all of the Medicare and insurance information.

Can you imagine the joy of trying to piece this information together from the confused remembering of this dear old woman? The amount of paper to sort through to find the answers? The minutes and hours on hold, the number of times you have to call back to give that one last piece of information?

Remember you are doing this to save this good woman from the near-final indignity of lying in her bed in a puddle of her own urine.

Short answer: it was fixed. I wanted to hurt someone, but with bureaucracy like this, there is no one to slap, just a mildly sympathetic voice on the phone (a different one each time), and I am not going to waste my energy screaming at a drone.

"All is squared away, Mr. DeSalvo," they told me. "The shipments will continue and we will notify you personally if there is ever any problem. We have you cell and work number on file, and you are now the designated contact on the file."

Good, I thought.

Fast forward 4 months.

Screw up of supplies delivery #2: I receive a voice mail. It seems that someone called in and canceled the ongoing order. There will be no September supplies.

Call #1: Confirming with the private supply company that "someone" who the computer "could not say" called and canceled the order, but that I should contact the hospice company, maybe they did it, and it cannot be restarted without confirmation from hospice.

Call #2: Hospice company - left message.

Call #3: Call from hospice nurse. She did not call and cancel. Confirms hospice cannot help or get involved with bladder. Promises to call hospice supervisor.

Call #4: Calls hospice supervisor and confirms above.

Call #5: Call to supply company confirming hospice. Transfers to different department. Transferred back to original department. Call disconnected.

Call #6: Call back to supply company. New operator. Everything explained again. Cannot start shipment again without supervisor approval and Medicare approval. Does not know how long it will take to get approval. Must take all information from me again: names, addresses, numbers, insurance number, date of birth. I ask whether she is using a computer. She confirms she already has all the information but I must provide it all to her again. Policy. Placed on hold while she consults supervisor. Everything is square. Shipment will be expedited.

REAL Exchange on the telephone during the call:

Operator: Okay, Mr. DeSalvo, I see that you are down for three boxes of bags, three boxes of the wafers, and 2 tubes of adhesive, right?

Me: Yes, that sounds right, from memory.

Operator: Well, you know you are eligible for 6 boxes of bags, six boxes of wafers, and 6 tubes of adhesive under Medicare guides, right?

Me: The bags last like 2 or 3 days, so if each box has 10 bags and wafers, why would someone need 6 boxes? That's like 6 months worth.

Operator: We can go ahead and increase that order because you are entitled to receive those six boxes.

Me: Why don't you just send us 4 boxes so we have some in case of a problem like we are having, but one tube of adhesive is plenty. She doesn't even use all of one tube in 3 months.

Operator: Medicare allows you six of each. Are you saying you don't want what Medicare says you should have? None of this is costing you any money.

Me: No thanks, I don't think she needs six boxes.

Operator: Are you sure, because its no trouble, we can just send six boxes right out.

Me: No, thanks.

Operator: Well if you change your mind, just remember, Medicare says you can have six.

Call #7: Voice message the very next day: "Your father's medical supplies have been placed on hold. Please call us at 800..."

Call #8: Call to supply company. Father not in system. Does not know why they called about father. Hold on mother's supplies. Does not know why I got that call. Promises to re-notate file with entire history. Promises to call back and confirm supplies on the way. [I know it is not over]


WHY does Medicare have a more than 36 trillion shortfall?

WHY did I have to solve the same non-problem twice in less than 9 months?

WHY all the telephone calls, ridiculous requirements, repetition and waste?

Why no government health care in America, no single payer system?

    It has been tried before. Its right here. It's called Medicare. And it is a nightmare.

Scott DeSalvo:

SOLO (Sense of Life Objectivists):

I have sympathy, I really do

atlascott's picture

It is sad to think that in such a technological age, care which the market would render routine and inexpensive has become outrageously expensive and a nightmare of bureaucracy.

Don't people understand that it is precisely ~because~ the government is already in the health care business that our system is screwed up?

The saddest part of all is pointed out by Brant.

Their "cure" will render all care more expensive, and if, God-forbid, single payer is enacted, those who remain uninsured will be hurt the worst.

They will have no access to alternate means of care as all care is routed through a labyrinthine bureaucracy with waste and political corruption built-in.

We must remember the amount of pork in the "Stimulus" Bill and remember that the same politicians are on board with this travesty.

I just read

Brant Gaede's picture

I just read that 25 million will remain uninsured under this destroy-the-economy piece of political-pork-enslave-the-doctors-and-the-nurses-and-the-patients crap.


Obama praises Senate committee's endorsement of health care

Marcus's picture

Barack Obama praises Senate committee's endorsement of health care reform

President Barack Obama has praised a key Senate committee's endorsement of sweeping health care overhaul as a "critical milestone" toward passing a reform package through Congress.

By Toby Harnden in Washington
13 Oct 2009

Thanks, Olivia

atlascott's picture

For your kindness.

And Sir De Salvo...

Olivia's picture are you.

What a hideous ordeal! Heart breaking.


atlascott's picture

Hard to believe this sort of fiasco is the gold standard of anything but incompetence.

Good on you for taking care of yours. In my book, you are a hero and a stand up guy.


Brant Gaede's picture

As bad as this is Obamacare will leave present-day Medicare as the gold standard for medical care in the U.S.

While my situation is not as bad as yours part of the reason is I as an expert care-giver can do everything any visiting nurse can do and I won't have them come by. I have also given up hundreds of thousands in earned income, but that is only to keep my Mother from being benign-neglected to death in assisted living or a nursing home. I've saved her life several times and in two weeks she'll be 95. 80% of people who reach 90 don't reach 95. They don't die off for any particular diagnosed medical condition. They die of this and they die of that. I'm convinced they simply don't get enough proper attentive care. Still, I don't know if she'll make it to 95, next month or next year.


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